At summit, AOA focuses on present and future of the patient experience

When the AOA Telehealth Council last called a summit with industry leaders on telemedicine, it was 2020 and the council was drafting a revision to its landmark policy statement on the remote technology’s proper place in patient care. The country was in the early throes of the pandemic then, just before the use of telemedicine technology escalated in health care settings.

Nearly two years after that first industry touch base, the focus has shifted—the lens has broadened to capture the entirety of the patient experience. The 2021 Patient Experience Summit Dec. 9-10 covered the gamut of the patient experience and was attended by industry leaders, the Telehealth Council, members of the AOA Board of Trustees, doctors of optometry, an optometry student and AOA advocacy staff.

“During the summit, we heard from industry regarding how their companies are developing tools, resources and products that can help doctors of optometry provide the best patient experience possible,” says Christopher Quinn, O.D., chair of the AOA Telehealth Council and past AOA president.

“The council will consider revisions to its policy statement, after being informed by future council discussions and finally the AOA Board of Trustees,” Dr. Quinn adds. “Patient satisfaction/engagement is a critical element of care delivered by telemedicine, and we need to better understand the patient experience with care delivered remotely. The information will inform us of necessary changes to the policy and better reflect the patient experience.”

Patient experience under the microscope

The patient experience, according to the Agency for Health Care Research and Quality, is a “range of interactions that patients have with the health care system, including their care from health plans and from doctors, nurses and staff in hospitals, physician practices, and other health care facilities. As an integral component of health care quality, patient experience includes several aspects of health care delivery that patients value highly when they seek and receive care, such as getting timely appointments, easy access to information, and good communication with health care providers.”

The AOA long has been a standard bearer for patient care, advocating for better access for patients and fighting to ensure they get the services and resources they need.

Amid a changing health care landscape, doctors of optometry must keep up with how the patient experience is evolving in order to deliver “best-in-class eye and vision care,” says AOA Board of Trustees member Terri A. Gossard, O.D., M.S.

“The Board of Trustees recognizes the importance of the evolution of the way our patients are accessing care and how doctors of optometry can best utilize technology,” says Dr. Gossard, trustee liaison to the council. “The AOA will work to amplify optometric access to innovations that will best serve our patients, while also identifying sub-standard models and products that could potentially be an obstacle to established standards of care.

“Just as we have embraced innovations in our exam rooms, doctors of optometry are focusing their attention on how the patient care journey continues to evolve,” she adds. “We should utilize technology and new processes to deliver our services in a way that meets patient appetite and demand, while ensuring high-quality patient outcomes continue to be our primary focus, directed by doctors of optometry.”

Says Steven T. Reed, O.D., AOA board secretary-treasurer and a liaison to the Telehealth Council: “It's very important that we, as board members, stay on our toes rather than our heels. It's our responsibility to help shape the future of optometry so that our patients are protected and receive the highest level of care. The care doctors of optometry provide each day merges what we know is best for the patient with the patient's expectations. Focusing on the patient experience is ultimately about positive outcomes. This creates a win-win for doctors and patients.”

GAO: Jury still out on telemedicine

In May, the Government Accountability Office (GAO) testified before the Senate’s finance committee on “Medicare and Medicaid: COVID-19 Program Flexibilities and Considerations for Their Continuation.” Under the pandemic, the Centers for Medicare & Medicaid Services (CMS) rolled out hundreds of program waivers and other responses to support patients’ access to care in the crisis.

Under Medicare’s, that included waiving in-person requirements for certain services, allowing health care providers to use audio and audio-video technology. Utilization jumped from an average of about 325,000 services per week in mid-March to about 1.9 million in mid-April 2020. Other waivers and flexibilities permitted hospitals to provide care in non-hospital settings, relaxation of provider enrollment rules, expanding the provider workforce by allowing nurse practitioners, for instance, to provide more services.

Under Medicaid, waivers and flexibilities allowed 43 states to suspend fee-for-service prior authorizations and 50 states and the District of Columbia waived some provider screening and enrollment requirements.

“While likely benefitting beneficiaries and providers, these program flexibilities also increase certain risks to the Medicare and Medicaid programs and raise considerations for their continuation beyond the pandemic,” they testified.

In testimony, GAO officials testified to a mixed bag of results. They reported: 

• Increased spending, if remote telehealth services were provided in addition to in-person services.
• Suspension of some program safeguards increase the risks of fraud, waste and abuse.
• Quality of service had not yet been fully analyzed, though by its nature, telemedicine enables safe provision of care.

In a study, “Assessment of Patient Preferences for Telehealth in Post-COVID-19 Pandemic Health Care Money,” published Dec. 1 in JAMA Network Open, patient attitudes about telehealth were continuing to evolve. Concluded the study:

“This survey study found that adult respondents were generally willing to use video visits but preferred in-person care to a video visit for a nonemergency health issue. Previous use of telehealth was associated with preference for video visits, and those who preferred video visits were more sensitive to out-of-pocket cost. Awareness of patient preferences will help to identify telehealth’s role in post-pandemic health care delivery.”

Telehealth expansion?

On Capitol Hill, bipartisan support for telehealth expansion has gained significant support. Though, of note, no meaningful legislative telehealth expansion has occurred during the COVID-19 era. In fact, some lawmakers have grown increasingly suspicious of the heavy lobbying efforts of large tech companies including Amazon and Google.

With telehealth waivers and exemptions set to expire once the public health emergency ends, these and other advocates are now pushing for Congress to avert what they are calling the “telehealth cliff.” One piece of legislation that would extend some pandemic-related relaxation of telehealth rules is the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021, which now has 61 bipartisan co-sponsors in the U.S. Senate and 115 in the House.

The CONNECT for Health Act would remove all geographic restrictions under Medicare and expand originating sites to include personal homes; would allow federally-qualified health centers to provide telehealth; and would give the U.S. Department of Health and Human Services permanent authority to waive telehealth restrictions. AOA Advocacy volunteer leaders and staff continue to urge lawmakers to keep working to ensure that any telehealth expansion is a clear benefit for patients and their doctors.

To learn more about optometry’s priority advocacy issues and help build greater support on Capitol Hill for these issues, visit the AOA’s Online Action Center or contact the AOA Advocacy Team directly at advocacy@aoa.org